Question 1

What is HCPCS code M1209?

Accepted Answer

HCPCS code M1209 is ">=2 same hi-rsk med w/o diag". At least two orders for high-risk medications from the same drug class, (table 4), without appropriate diagnoses

Question 2

What category is M1209 in?

Accepted Answer

M1209 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M1209?

Accepted Answer

Use M1209 when billing for >=2 same hi-rsk med w/o diag. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is M1209 covered by Medicare?

Accepted Answer

Coverage for M1209 (>=2 same hi-rsk med w/o diag) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for M1209?

Accepted Answer

Documentation for M1209 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).